Herpes Herpes Treatments What is herpes? Herpes is a term that generally refers to a family of viral infections characterized by painful, fluid-filled sores or blisters in and around the mouth or genital region. Herpes is also called herpes simplex, which includes two types: Genital herpes is a common sexually transmitted disease (STD) marked by outbreaks of blisters and lesions in the genital area. Genital herpes is most often caused by infection of the herpes simplex virus type 2 (HSV-2).About one out of six people 14 to 49 years of age has genital herpes caused by the HSV-2 infection, according to the Centers for Disease Control and Infection (Source: CDC ). Another herpes virus, herpes simplex virus type 1 (HSV-1), which generally causes oral herpes, can also cause genital herpes. Oral herpes (herpes simplex labialis) is a very common disease that causes small, painful cold sores and fever blisters of the mouth, lips or gums. Oral herpes is most often caused by HSV-1, but HSV-2 may also be responsible in some cases.

It is estimated that 50% to 80% of all American adults have oral herpes, according to the Centers for Disease Control and Infection. HSV-1 and HSV-2 are closely related viruses that belong to a larger family of herpes viruses that can cause a variety of other diseases. Other common types of herpes viruses include cytomegalovirus (CMV), herpes zoster (causes shingles and chickenpox), and Epstein-Barr virus (can cause mononucleosis and other infections). Looking for a Doctor? Search Now Find an Infectious Disease Specialist Herpes simplex virus infections are very contagious and can be spread to either the genital or oral areas by direct contact with herpes sores or blisters, or skin, saliva, or mucus membranes infected with a herpes simplex virus. Herpes is not curable, but it is preventable and controllable in many cases. Dangers of Mixing Alcohol and Hepatitis C In some cases, herpes can lead to serious complications, such as meningitis, blindness, or death of a newborn that was exposed to the disease during pregnancy or delivery.

Seek prompt medical care if you are pregnant or have a disease or condition that suppresses the immune system, and believe that you have been exposed to herpes or have herpes symptoms, such as sores or blisters in the genital or oral area. What is Herpes Labialis? What is Herpes Labialis? By Sally Robertson , BSc Herpes labialis or oral herpes is an infection of the mouth area that causes small, painful blisters to develop on the lips, gums or throat. These blisters are caused by the herpes simplex virus, a common and highly contagious virus that infects most people in the U.S by time they reach the age of 20. There are three stages of infection that occur in oral herpes, which include the primary infection, the latency period and recurrence. During the initial stage of infection, the virus enters the skin or mucosal membrane, where it then reproduces. Blisters and other symptoms such as fever may develop, although the virus sometimes does not cause any symptoms. After primary infection, the virus lies dormant inside the nervous tissue of the spine where it reproduces but remains inactive.

Later in life, the virus can reactivate, particularly in cases of emotional or physical distress, and lead to the development of further sores and symptoms. When this occurs, a person is said to have recurrent oral herpes. Recurrent herpes is not a serious condition, but many people use over-the-counter treatments to relieve their symptoms, which usually resolve within a few weeks. In some people, the cold sores recur around two or three times every year, while other people only experience a cold sore once and never again. In general, recurrent infections lead to milder symptoms than primary infection. Symptoms Symptoms do not present immediately after infection with herpes simplex virus and cold sores usually emerge within one to three weeks after initial contact with the virus. People typically experience a tingling or burning sensation around areas of the mouth, which is followed by the appearance of small blisters, usually at the edge of the lower lip. Fever, sore throat, sore lymph nodes in the neck, painful swallowing and muscle aches may also manifest. Usually, symptoms occur in children aged between 1 and 5 years, although they can affect people of any age and at any time. The symptoms of oral herpes usually last for up to three weeks.

When many blisters develop, the term “outbreak” may be used and the patient may present with any of the following: Red blisters that burst and leak Many small blisters that grow together to form one large blister Small blisters containing clear or yellowish fluid A crusty, yellow blister Causes of herpes labialis Herpes labialis is so named because the cold sore typically affects the lips. The infection is usually caused by herpes simplex virus type 1 (HSV-1) but occasionally herpes simplex virus type 2 (HSV-2) is responsible. The HSV-2 infection is usually transmitted through having oral sex with someone who has a genital herpes infection. In genital herpes, painful blisters develop in and around the groin. The herpes virus is spread easily and people can catch the virus if they have close personal contact with an infected individual or if they touch objects on which the virus may be present such as towels, razors, dishes or other items that may get shared. Once the virus lays dormant inside nerve cells, certain events can increase the likelihood of recurrence.

Examples of these events include: Fatigue Upper respiratory infection Treatment of herpes labialis Cold sores usually resolve independently within ten days of onset, but antiviral creams can be bought over the counter to help ease symptoms and accelerate healing. However, these creams tend to be expensive and often only relieve symptoms for between a few hours and one day. Cold sore patches containing hydrocolloid gel can also help to heal skin wounds. For severe cases of herpes labialis, antiviral tablets may be prescribed and examples include acclovir, famciclovir and valacyclovir.These antiviral agents are more effective if they are taken as soon as symptoms first present (e.g. when tingling is felt around the mouth) and before the blisters first appear. However, these medications cannot cure oral herpes and it is still possible for the patient to spread the virus to those around them.

Some examples of self-help measures people can take to alleviate their symptoms include the following: Washing the blisters with antiseptic soap and water to help prevent spread of the virus to other areas of the body Applying ice to the blisters to help relieve pain Avoiding hot drinks and spicy or salty foods Gargling with cool water Taking pain killers Long-term Outlook Although symptoms after initial infection usually resolve within three weeks, recurrence can occur on a frequent basis. However, the severity and frequency of the recurring symptoms usually diminish as people age. Infections that occur in immuno-compromised individuals can be severe and these people should seek medical advice if they develop oral herpes. What is Herpes Labialis? (with pictures) What is Herpes Labialis? Written By: Jessica F. Black Edited By: Allegra J. Lingo Last Modified Date: 18 December 2016 Copyright Protected: You won't believe these 10 facts about people Herpes labialis is a type of herpes simplex virus that infects the gums, mouth, and lips with blisters. Two common names for herpes labialis are fever blisters and cold sores . The first signs of infection are heightened sensitivity, itching, and a burning sensation around or in the mouth.

The warning signs are usually followed by the presence of painful blisters, and precautions should be taken because the virus is contagious. Blisters associated with this virus are usually red, inflamed, and seep yellow fluids that can form a crust around the sore. The location and intensity of the blisters can cause severe pain, and the virus often requires medical attention. This infection is typically recurring because the virus resides in the facial nerve tissue but these outbreaks are generally less severe. A physician can sometimes identify herpes labialis with a visual examination, but viral cultures are available for further diagnosis. The frequent recurrence of blisters can be difficult to treat because of both the continuous activity of the infection and the inability to treat existing sores before new blisters emerge. An infection can spread to other areas of the body due to the contagious nature of herpes labialis. The virus may sometimes lead to different bacterial infections, making the disease harder to contain. There are various triggers that accelerate recurrence based on individual body and skin types. Sun exposure, menstrual cycles, and stress can cause the onset of sores. Ad There are numerous ways that herpes labialis can be transmitted or contracted by others.

When the infection is active and there are visible sores, people should avoid kissing and sharing silverware, toothbrushes, wash cloths, or other items that come in contact with the infected area. The use of a mild anti-bacterial soap is usually suggested for cleaning the area and disinfecting the hands. There are treatments available for herpes labialis that can reduce pain associated with the virus and typically help prevent incessant recurrence. Although some symptoms usually subside on their own after about a week, there are oral and topical medications available. The prescribed oral medications generally treat symptoms and help prevent an outbreak. Topical ointments are either prescribed or purchased over the counter, and assist in soothing and reducing symptoms. There are different stages of the virus, and antiviral treatment is typically more beneficial than allowing the infection to run its course. The predominately infected area should be kept clean, and contact with the area should be minimized to avoid spreading. Ad Herpes - oral: MedlinePlus Medical Encyclopedia If the symptoms return later, they are usually more mild in most cases. Exams and Tests Your health care provider can diagnose oral herpes by looking at your mouth area. Sometimes, a sample of the sore is taken and sent to a laboratory for closer examination.

Tests may include: Viral culture Tzanck test to check for HSV Treatment Symptoms may go away on their own without treatment in 1 to 2 weeks. Your provider can prescribe medicines to fight the virus. This is called antiviral medicine. It can help reduce pain and make your symptoms go away sooner. Medicines used to treat mouth sores include: Acyclovir Famciclovir Valacyclovir These medicines work best if you take them when you have warning signs of a mouth sore, before any blisters develop. If you get mouth sores frequently, you may need to take these medicines all the time. Antiviral skin creams may also be used. However, they are expensive and often only shorten the outbreak by a few hours to a day. The following steps can also help make you feel better: Apply ice or a warm washcloth to the sores to help ease pain. Wash the blisters gently with germ-fighting (antiseptic) soap and water. This helps prevent spreading the virus to other body areas. Avoid hot beverages, spicy and salty foods, and citrus. Gargle with cool water or eat popsicles. Rinse with salt water.

Take a pain reliever such as acetaminophen (Tylenol). Outlook (Prognosis) Oral herpes most often goes away by itself in 1 to 2 weeks. However, it may come back. Herpes infection may be severe and dangerous if: It occurs in or near the eye. You have a weakened immune system due to certain diseases and medicines. Possible Complications Herpes infection of the eye is a leading cause of blindness in the United States. It causes scarring of the cornea. Other complications of oral herpes may include: Return of mouth sores and blisters Spread of the virus to other skin areas Bacterial skin infection Widespread body infection, which may be life threatening in people who have a weakened immune system due to atopic dermatitis , cancer , or HIV infection When to Contact a Medical Professional Call your provider if you have: Symptoms that are severe or that don't go away after 2 weeks Sores or blisters near your eyes Herpes symptoms and a weakened immune system due to certain diseases or medicines Prevention Here are some tips to prevent mouth sores: Apply sunblock or lip balm containing zinc oxide to your lips before you go outside.

Apply a moisturizing balm to prevent the lips from becoming too dry. Avoid direct contact with herpes sores. Wash items such as towels and linens in boiling hot water after each use. Do not share utensils, straws, glasses, or other items if someone has oral herpes. Do not have oral sex if you have oral herpes, especially if you have blisters. You can spread the virus to the genitals. Both oral and genital herpes viruses can sometimes be spread, even when you do not have mouth sores or blisters. Alternative Names Cold sore; Fever blister; Oral herpes simplex; Herpes labialis; Herpes simplex Images Herpes simplex - close-up References Habif TP. Warts, herpes simplex, and other viral infections. In: Habif TP, ed. Clinical Dermatology. 6th ed. St. Louis, MO: Elsevier Saunders; 2016:chap 12. Mendoza N, Madkan V, Sra K, et al. Human herpesviruses. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds. Dermatology. 3rd ed.

Philadelphia, PA: Elsevier Mosby; 2012:chap 80. Whitley RJ. Herpes simplex virus infections. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 374. Read More Labialis Labialis Tweet Oral Herpes Labialis is a term used to describe the Herpes simplex virus when it is infecting the mouth region of the body. HSV, or herpes simplex virus is also known for causing genital herpes.Both conditions are incurable. Labialis is characterized in the cold sores that are often called fever blisters that show up on the face, mouth or the throat of those experiencing an outbreak. Those that could be suffering from this condition should seek out the help of their doctor so that they can reduce the number of outbreaks they have as well as lessening the intensity of them. Oral and genital herpes is a growingly common disease that there is help for. Symptoms Of Labialis Sometimes called oral herpes or mouth herpes, the condition is characterized by its symptoms.

Usually, the first physical signs of the disease are small blisters that form on the lips as well as on the outer edge of the lip and mouth area. These blisters are often filled with fluid and are itchy. They can also be red and very irritated. The inflamed skin is sensitive to the touch. Usually, they will go through a cycle. First the virus presents itself as an inflamed area of the skin often red and slightly swollen. Within days, blisters form in these areas. The blisters will eventually break open, and the fluid will dry out. Then, these sores will scab over until they heal completely. Additional symptoms of herpes labialis include fever, sore throat and swollen lymph glands. Many times, the body will experience symptoms similar to that of fighting off any other infection. There are two types of the herpes virus. HSV 1 and HSV 2 are the two distinctions. Both types of the virus can cause oral herpes to be present as well as cause genital herpes. Your doctor will use herpes testing to determine which you have. How Does It Spread? The herpes virus spreads when contact is made with a person that has the virus to a person that does not.

Genital herpes most commonly spreads through sexual intercourse or contact with the genitals of an infected person. Oral herpes can be gotten from having oral sex when an individual’s genitals have an outbreak of the virus . In addition, herpes liabialis can be spread through kissing a person that has the virus, sharing utensils with someone that has an outbreak or through other contact with the infected skin during an outbreak. In addition, doctors believe that the herpes simplex virus can spread when the individual is not experiencing an outbreak, though the risk of spreading herpes then is much less. How Is Herpes Treated? Herpes medicine is used to treat the condition . There is no cure for liabialis or genital herpes. Medications given to the patient can help to reduce the number of outbreaks that they have and reduce the intensity of those outbreaks they do have. This can also lessen the risk of passing the condition on to someone else. The herpes virus also has a herpes vaccine which can help individuals to prevent themselves from getting the disease. If you believe that you could be suffering from any of the symptoms of labialis or herpes of the mouth, it is essential to seek out medical attention for it. It is easy to spread the herpes virus.

Take the time to use pics of herpes to help you to determine if you could have the signs of the virus. Simple cold sores can be easily spread from person to person, including to children. With herpes medicine you reduce the risk of infecting someone else and get relief that is nearly always needed. Oral Herpes - National Library of Medicine - PubMed Health Antiviral agents for treatment of herpes simplex virus infection in neonates The virus herpes simplex (herpes) causes a rare but devastating disease in the newborn that can range from skin and eye infection to shock, organ failure, brain infection, and death. Newborn herpes infection is an uncommon complication of active genital herpes in the mother around the time of delivery or after direct contact with a herpes blister ("fever blister", "cold sore") of an infected caregiver. We reviewed five studies conducted to assess the effects of antiviral agents (medications that reduce the spread of virus in the body) on mortality and long‐term complications of herpes disease in the newborn. Antiviral agents were shown to reduce mortality from the condition, but the reduction was not statistically significant due to the small number of infants in the study.

There was insufficient trial data to guide caregivers regarding the duration of antiviral therapy or dose. Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer Treatment of cancer is increasingly effective, but associated with oral complications such as mucositis, fungal infections, bacterial infections and viral infections such as the herpes simplex virus (HSV). Oral complications can impact severely on quality of life and may lead to life‐threatening systemic infection. Infection with HSV can cause pain and blistering on or around the lips and within the mouth. Orofacial lesions are most commonly caused by HSV type 1. Aciclovir and other antiviral drugs such as valaciclovir, famiciclovir and penciclovir, have been widely used to treat HSV‐related conditions. Recurrent HSV type 1 infection in patients who are immunocompromised due to treatment for cancer may be more aggressive, painful and slower to heal. These more extensive lesions often require much longer treatment and leave the patient more susceptible to developing drug‐resistant strains of HSV.

This review of 17 trials found evidence that aciclovir is efficacious in the prevention and treatment of HSV infections, in terms of preventing clinical/culture positive HSV infections, reduction in healing time, duration of viral shedding and relief of pain. There is no evidence that valaciclovir is more efficacious than aciclovir, or that a high dose of valaciclovir is better than a low dose of valaciclovir. There is evidence that for prevention, placebo is more efficacious than prostaglandin E. However, in all included trials, risk of bias is unclear. No trials reported on duration of hospital stay, amount of analgesia or patient quality of life. Antiviral agents for treatment of herpes simplex virus infection in neonates The virus herpes simplex (herpes) causes a rare but devastating disease in the newborn that can range from skin and eye infection to shock, organ failure, brain infection, and death. Newborn herpes infection is an uncommon complication of active genital herpes in the mother around the time of delivery or after direct contact with a herpes blister ("fever blister", "cold sore") of an infected caregiver.

We reviewed five studies conducted to assess the effects of antiviral agents (medications that reduce the spread of virus in the body) on mortality and long‐term complications of herpes disease in the newborn. Antiviral agents were shown to reduce mortality from the condition, but the reduction was not statistically significant due to the small number of infants in the study. There was insufficient trial data to guide caregivers regarding the duration of antiviral therapy or dose. Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer Treatment of cancer is increasingly effective, but associated with oral complications such as mucositis, fungal infections, bacterial infections and viral infections such as the herpes simplex virus (HSV). Oral complications can impact severely on quality of life and may lead to life‐threatening systemic infection. Infection with HSV can cause pain and blistering on or around the lips and within the mouth. Orofacial lesions are most commonly caused by HSV type 1. Aciclovir and other antiviral drugs such as valaciclovir, famiciclovir and penciclovir, have been widely used to treat HSV‐related conditions.

Recurrent HSV type 1 infection in patients who are immunocompromised due to treatment for cancer may be more aggressive, painful and slower to heal. These more extensive lesions often require much longer treatment and leave the patient more susceptible to developing drug‐resistant strains of HSV. This review of 17 trials found evidence that aciclovir is efficacious in the prevention and treatment of HSV infections, in terms of preventing clinical/culture positive HSV infections, reduction in healing time, duration of viral shedding and relief of pain. There is no evidence that valaciclovir is more efficacious than aciclovir, or that a high dose of valaciclovir is better than a low dose of valaciclovir. There is evidence that for prevention, placebo is more efficacious than prostaglandin E. However, in all included trials, risk of bias is unclear. No trials reported on duration of hospital stay, amount of analgesia or patient quality of life. Nongenital Herpes Simplex Virus - American Family Physician Nongenital Herpes Simplex Virus RICHARD P.

USATINE, MD, and ROCHELLE TINITIGAN, MD, University of Texas Health Science Center, San Antonio, Texas Am Fam Physician. 2010 Nov 1;82(9):1075-1082. Patient information: See related handout on cold sores , written by the authors of this article. References Nongenital herpes simplex virus type 1 is a common infection usually transmitted during childhood via nonsexual contact. Most of these infections involve the oral mucosa or lips (herpes labialis). The diagnosis of an infection with herpes simplex virus type 1 is usually made by the appearance of the lesions (grouped vesicles or ulcers on an erythematous base) and patient history. However, if uncertain, the diagnosis of herpes labialis can be made by viral culture, polymerase chain reaction, serology, direct fluorescent antibody testing, or Tzanck test. Other nonoral herpes simplex virus type 1 infections include herpetic keratitis, herpetic whitlow, herpes gladiatorum, and herpetic sycosis of the beard area.

The differential diagnosis of nongenital herpes simplex virus infection includes aphthous ulcers, acute paronychia, varicellazoster virus infection, herpangina, herpes gestationis (pemphigoid gestationis), pemphigus vulgaris, and Behçet syndrome. Oral acyclovir suspension is an effective treatment for children with primary herpetic gingivostomatitis. Oral acyclovir, valacyclovir, and famciclovir are effective in treating acute recurrence of herpes labialis (cold sores). Recurrences of herpes labialis may be diminished with daily oral acyclovir or valacyclovir. Topical acyclovir, penciclovir, and docosanol are optional treatments for recurrent herpes labialis, but they are less effective than oral treatment. Nongenital herpes simplex virus type 1 (HSV-1) is a common infection that most often involves the oral mucosa or lips (herpes labialis). The primary oral infection may range from asymptomatic to very painful, leading to poor oral intake and dehydration. Recurrent infections cause cold sores that can affect appearance and quality of life.

Although HSV-2 also can affect the oral mucosa, this is much less common and does not tend to become recurrent. SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Oral acyclovir suspension (Zovirax) is an effective treatment for children with primary herpetic gingivostomatitis. B Oral acyclovir, valacyclovir (Valtrex), and famciclovir (Famvir) are effective for the treatment of acute recurrences of herpes labialis. A Recurrences of herpes labialis are suppressed with daily oral acyclovir or valacyclovir. A Topical acyclovir, penciclovir (Denavir), and docosanol (Abreva) are optional treatments for recurrent herpes labialis. A A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .

SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Oral acyclovir suspension (Zovirax) is an effective treatment for children with primary herpetic gingivostomatitis. B Oral acyclovir, valacyclovir (Valtrex), and famciclovir (Famvir) are effective for the treatment of acute recurrences of herpes labialis. A Recurrences of herpes labialis are suppressed with daily oral acyclovir or valacyclovir. A Topical acyclovir, penciclovir (Denavir), and docosanol (Abreva) are optional treatments for recurrent herpes labialis. A A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to . Epidemiology References HSV-1 is initially transmitted in childhood via nonsexual contact, but it may be acquired in young adulthood through sexual contact.

In the United States, the seroprevalence of HSV-1 decreased from 62.0 percent between 1988 and 1994 to 57.7 percent between 1999 and 2004. 1 In a cross-sectional survey of U.S. college students, the prevalence of HSV-1 antibodies was 37.2 percent in freshmen and 46.1 percent in fourth-year students. 2 A history of cold sores was reported in 25.6 percent of freshmen and 28 percent of fourth-year students. Significant predictors of HSV-1 antibodies in this population were female sex, sexual intercourse before 15 years of age, greater total years of sexual activity, history of a partner with oral sores, and personal history of a non-HSV sexually transmitted disease. 2 Approximately 90 percent of recurrent HSV-1 infections cause the orofacial lesions known as herpes labialis 3 ( Figure 1 ). View/Print Figure Figure 1. Young girl with recurrent herpes simplex virus type 1 showing vesicles on a red base at the vermilion border. Copyright © Richard P. Usatine, MD Figure 1.

Young girl with recurrent herpes simplex virus type 1 showing vesicles on a red base at the vermilion border. Copyright © Richard P. Usatine, MD Pathophysiology References HSV invades and replicates in neurons, as well as in epidermal and dermal cells. The virus travels from the skin during contact to the sensory dorsal root ganglion, where latency is established. Oral HSV-1 infections reactivate from the trigeminal sensory ganglia, affecting the facial, oral, labial, oropharyngeal, and ocular mucosa. Primary infection appears two to 20 days after contact with an infected person. The virus can be transmitted by kissing or sharing utensils or towels. Transmission involves mucous membranes and open or abraded skin. During one study of herpes labialis, the median duration of HSV-1 shedding was 60 hours when measured by polymerase chain reaction (PCR) and 48 hours when measured by culture. 4 Peak viral DNA load occurred at 48 hours, with no virus detected beyond 96 hours of onset of symptoms.

4 Recurrent infections may be precipitated by various stimuli, such as stress, fever, sun exposure, extremes in temperature, ultraviolet radiation, immunosuppression, or trauma. The virus remains dormant for a variable amount of time. Oral HSV-1 usually recurs one to six times per year. 5 The duration of symptoms is shorter and the symptoms are less severe during a recurrence. The likelihood of reactivation of HSV infection differs between HSV-1 and HSV-2, and between the sacral and trigeminal anatomic sites. In one study, the mean monthly frequencies of recurrence were 0.33 genital HSV-2 infections, 0.12 orolabial HSV-1 infections, 0.020 genital HSV-1 infections, and 0.001 oral HSV-2 infections. 6 This shows that recurrences are more likely when HSV-1 is oral and HSV-2 is genital. Clinical Presentation References In primary oral HSV-1, symptoms may include a prodrome of fever, followed by mouth lesions with submandibular and cervical lymphadenopathy.

The mouth lesions (herpetic gingivostomatitis) consist of painful vesicles on a red, swollen base that occur on the lips, gingiva, oral palate, or tongue. The lesions ulcerate ( Figure 2 ) and the pain can be severe. Refusal to eat or drink may be a clue to the presence of oral HSV. The lesions usually heal within 10 to 14 days. 5 View/Print Figure Figure 2. Primary herpetic gingivostomatitis caused by herpes simplex virus type 1 shown in (A) a four-year-old girl with lower lip ulcers and crusting on the upper lip, and (B) a two-year-old girl with ulcers on the lower lip and tongue. Both patients show visible gingivitis with reddened, inflamed, and swollen gums. Copyright © Richard P. Usatine, MD Figure 2. Primary herpetic gingivostomatitis caused by herpes simplex virus type 1 shown in (A) a four-year-old girl with lower lip ulcers and crusting on the upper lip, and (B) a two-year-old girl with ulcers on the lower lip and tongue.

Both patients show visible gingivitis with reddened, inflamed, and swollen gums. Copyright © Richard P. Usatine, MD In recurrent herpes labialis, symptoms of tingling, pain, paresthesias, itching, and burning precede the lesions in 60 percent of persons. 5 The lesions then appear as clusters of vesicles on the lip or vermilion border ( Figure 1 ). The vesicles may have an erythematous base. The lesions subsequently ulcerate and form a crust ( Figure 3 ). Healing begins within three to four days, and reepithelization may take seven to eight days. 5 However, many persons who are exposed to HSV-1 demonstrate asymptomatic seroconversion. View/Print Figure Figure 3. (A) Ulcers that form after the vesicles break, as shown in an adult women with herpes labialis. (B) Recurrent herpes simplex virus type 1 in the crusting stage seen at the vermilion border. Copyright © Richard P. Usatine, MD Figure 3. (A) Ulcers that form after the vesicles break, as shown in an adult women with herpes labialis.

(B) Recurrent herpes simplex virus type 1 in the crusting stage seen at the vermilion border. Copyright © Richard P. Usatine, MD Herpetic keratitis is an HSV infection of the eye. Common symptoms are eye pain, light sensitivity, and discharge with gritty sensation in the eye. Fluorescein stain with a ultraviolet light may show a classic dendritic ulcer on the cornea ( Figure 4 7 ). Without prompt treatment, scarring of the cornea may occur ( Figure 5 ). Herpetic keratitis with corneal clouding in a 56-year-old woman. Copyright © Richard P. Usatine, MD Herpetic whitlow is a vesicular lesion found on the hands or digits ( Figures 6 8 and 7 ). It occurs in children who suck their thumbs or medical and dental workers exposed to HSV-1 while not wearing gloves. Herpes gladiatorum is often seen in athletes who wrestle, which may put them in close physical contact with an infected person. Vesicular eruptions are often seen on the torso, but can occur in any location where skin-to-skin contact has occurred.

Herpetic sycosis is a follicular infection with HSV that causes vesiculopapular lesions in the beard area. It is often caused by autoinoculation from shaving. View/Print Figure Figure 9. Vesicles on a red base of the wrist in a woman with herpes gestationis after the loss of a pregnancy. Although the term “herpes” is used because the lesions appear herpetic, herpes simplex virus is not involved in the process and a better name for this condition is “pemphigoid gestationis.” Copyright © Richard P. Usatine, MD Figure 9. Vesicles on a red base of the wrist in a woman with herpes gestationis after the loss of a pregnancy. Although the term “herpes” is used because the lesions appear herpetic, herpes simplex virus is not involved in the process and a better name for this condition is “pemphigoid gestationis.” Copyright © Richard P. Usatine, MD Diagnosis References The diagnosis of HSV-1 infection is usually made by the appearance of the lesions and the patient's history.

However, if the pattern of the lesions is not specific to HSV, its diagnosis can be made by viral culture, PCR, serology, direct fluorescent antibody testing, or Tzanck test. Viral culture should be obtained from vesicles when possible. The vesicle should be unroofed with a scalpel or sterile needle, and a swab should be used to soak up the fluid and to scrape the base. The swab should be sent in special viral transport media directly to the laboratory (or placed on ice if transport will be delayed). Vesicles contain the highest titers of virus within the first 24 to 48 hours of their appearance (89 percent positive). 9 In general, viral culture for all types of HSV has a sensitivity of approximately 50 percent. 6 Viral isolates usually grow in tissue culture by five days. PCR is a more sensitive method in the laboratory diagnosis of HSV infection. 4 It is useful for the detection of asymptomatic viral shedding. Direct fluorescent antibody testing may be performed from air-dried specimens, and can detect 80 percent of true HSV-positive cases compared with culture results.

10 Immunoglobulin G antibodies that are type-specific to HSV develop the first several weeks after infection and persist indefinitely. A Tzanck test is difficult to perform correctly without specific training in its use, but it may be done in the office setting by scraping the floor of the herpetic vesicle, staining the specimen, and looking for multinucleated giant cells. Its results do not specify the type of HSV infection, but if done correctly, its sensitivity is 40 to 77 percent for acute herpetic gingivostomatitis. 11 Management References EPISODIC ORAL TREATMENT FOR PRIMARY HERPETIC GINGIVOSTOMATITIS Oral acyclovir suspension (Zovirax; 15 mg per kg five times per day for seven days) can be used to treat herpetic gingivostomatitis in young children. In one randomized controlled trial (RCT), children receiving acyclovir had oral lesions for a shorter time than children receiving placebo (median of four versus 10 days). The treatment group also had earlier resolution of the following signs and symptoms: fever (one versus three days); eating difficulties (four versus seven days); and drinking difficulties (three versus six days).

12 Viral shedding was significantly shorter in the group treated with acyclovir (one versus five days). 12 Children should be treated symptomatically with oral analgesics and cold, soothing foods such as ice pops and ice cream. Various concoctions of topical anesthetics and other medications have been used to numb the painful ulcers so that children can be kept well hydrated. EPISODIC ORAL TREATMENT FOR RECURRENT HERPES LABIALIS In a Cochrane review on the treatment of herpes labialis in patients receiving cancer treatment, acyclovir was found to be effective with regard to viral shedding (median of 2.5 versus 17.0 days); time to first decrease in pain (median of three versus 16 days); complete resolution of pain (9.9 versus 13.6 days); and total healing (median of 13.9 versus 20.7 days). 13 The brief period of viral replication in recurrent herpes labialis lesions suggests short therapeutic regimens should produce good results.

In one RCT, 701 patients self-initiated therapy with famciclovir (Famvir; 1,500 mg once [single dose] or 750 mg twice per day for one day [single day]) or placebo within one hour of prodromal symptoms onset. 14 Median healing times of primary (first to appear) vesicular lesions in the famciclovir single-dose, famciclovir single-day, and placebo groups were 4.4, 4.0, and 6.2 days, respectively. 14 Famciclovir showed decreased healing times, with no significant difference between the divided- or single-dose famciclovir treatment groups. 14 In one RCT of recurrent herpes labialis, treatment with oral valacyclovir (Valtrex) plus topical clobetasol (Temovate) was compared with placebo. 15 The patients took oral valacyclovir (2 g twice for one day) and applied clobetasol 0.05% gel (twice per day for three days) at onset of symptoms.

There were more aborted lesions in the valacyclovirclobetasol group compared with the placebo-placebo group (50 versus 15.8 percent). Combination therapy reduced the mean maximum lesion size (9.7 versus 54 mm) and the mean healing time (5.8 versus 9.3 days) of classic lesions. 15 EPISODIC TOPICAL TREATMENT FOR RECURRENT HERPES LABIALIS Topical treatment for herpes labialis is less effective than oral treatment. An RCT of treatment with topical penciclovir 1% cream (Denavir) showed healing was marginally faster in the penciclovir group compared with placebo (4.8 versus 5.5 days). 16 The participants were adults in otherwise good health who had at least three episodes of herpes labialis per year. They applied penciclovir cream or placebo within one hour of the first sign or symptom of a recurrence, and then every two hours while awake for four days. Resolution of symptoms occurred more rapidly in the penciclovir group regardless of whether the medication was applied in the early or late stage.

Penciclovir cream applied every two hours while awake reduced median duration of pain from 4.1 to 3.5 days, sped up the healing of classic lesions (e.g., vesicles, ulcers, crusts) from 5.5 to 4.8 days, and did not change median time of viral shedding (median of three versus three days). 16 Docosanol cream (Abreva) is a saturated, 22-carbon, aliphatic alcohol with antiviral activity. It is available without prescription. One RCT of 743 patients with herpes labialis showed a faster healing time in patients treated with docosanol 10% cream compared with placebo cream (4.1 versus 4.8 days), as well as reduced duration of pain symptoms (2.2 versus 2.7 days). 17 More than 90 percent of patients in both groups healed completely within 10 days. 17 Treatment with docosanol cream, when applied five times per day and within 12 hours of episode onset, is safe and somewhat effective.

An RCT of healthy adults with a history of frequent herpes labialis recurrences evaluated treatment with 5% acyclovir cream versus a vehicle control. 18 Participants were told to self-initiate treatment five times per day for four days, beginning within one hour of the onset of a recurrent episode. In study 1, the mean duration of episodes was 4.3 days for patients treated with acyclovir cream and 4.8 days for those treated with the vehicle control. 18 In study 2, the mean duration of episodes was 4.6 days for patients treated with acyclovir and 5.2 days for those treated with the vehicle control. 18 ORAL TREATMENT TO PREVENT HERPES LABIALIS RECURRENCES Oral acyclovir is effective in suppressing herpes labialis in immunocompetent adults with frequent recurrences. In one RCT, treatment with oral acyclovir (400 mg twice per day) resulted in a 53 percent reduction in the number of clinical recurrences and a 71 percent reduction in virus culture-positive recurrences compared with placebo.

19 The median time to first clinically documented recurrence was 46 days for placebo courses and 118 days for acyclovir courses. 19 The mean number of recurrences per four-month treatment period was 1.80 episodes per patient during placebo treatment and 0.85 episodes per patient during acyclovir treatment. 19 Treatment with oral valacyclovir (500 mg per day) for 16 weeks was compared with placebo in the suppression of herpes labialis in patients with a history of four or more recurrent lesions in the previous year. 20 Results showed 60 percent of persons in the valacyclovir group were recurrence-free throughout the study period compared with 38 percent in the placebo group. The mean time to first recurrence was longer with valacyclovir (13.1 weeks) compared with placebo (9.6 weeks). 20 In a Cochrane review of herpes labialis prevention in patients receiving treatment for cancer, acyclovir was found to be effective in the prevention of HSV infections, as measured by oral lesions or viral isolates (relative risk = 0.16 and 0.17, respectively).

13 There also was no evidence that valacyclovir is more effective than acyclovir. In another study, daily valacyclovir (500 mg per day) and acyclovir (400 mg twice per day) were equally effective in the prevention of recurrent HSV eye disease. 21 An overview of treatments for herpes labialis is provided in Table 2 . 12 – 20

Question: What is the common name for labialis herpes?
Answer: COLD SORE